DreamsOfSkinny

United healthcare

So far I have a 7 page appeal letter with all of my documentation from previous denials and issues and then about 50 resources (each also printed and highlighted for info referencing). I am still being denied because I don't have a BMI of 40 for the last 5 years (even though my insurance summary plan description only states I need a diagnosis of morbid obesity from a physician for last 5 years -which I have- and standard for morbid obesity is Bmi of 40 OR 35 with 1 co-morbidity). The insurance has said there is specific language in my SPD that isn't even in there (I have copy and talked to employer and advocate) saying it has to be class III morbid obesity and a minimum of BmI of 40. I'm fighting this and hope with all of this package that someone will review it and see that I was denied 3 x's based on errors on UHC's side. I also got 3 more letters from physicians treating my pseuddotumor cerebri in support of surgery. Sending off tomorrow

Yay for you!! Exciting!!

Don't give up! Unless your plan specifically states you need a BMI of 40 minimum, and only says "morbid obesity", then you should keep in mind for appeal to look up and reference all of the "industry standard" info out there stating "morbid obesity" is defined as BmI of 40+ OR 35+ with at least 1 co-morbidity directly related or exasperated by obesity. That's my fight right now. Last night I found TONS of references online that use this definition- most all bariatric surgeons use it, NIH defined it this way in 1991, most insurance companies within their own bariatric policies define it this way, Heart, Lung, Center for Disease (or something like that) uses it, most state insurance LAWS define it this way, medicaid uses this definition, etc. I'm going to literally reference like 50 sources and see what my insurance then wants to say is "standard medical definition". Mine is self-funded, so requirements are determined by my employer, and ironically the insurance companies OWN bariatric policy for their fully funded plans USE this definition. Lol! Good luck! Don't give up!

Insurance is definitely a fight! Battle! Ughhhh..... Frustrating so much sometimes. But it's sad when the insurance keeps telling me - just submit a 2nd level appeal and state all of the issues you've had with us so they will be addressed.... I kind of felt like their supervisors were almost hinting to me... just file the 2nd level appeal. So I'm starting on that and hope to get mailed off by Monday. I now have an additional letter for my co-morbidity from a Doctor and have a 2nd Doctor writing a letter supporting the surgery for this other health issue I'm having (and can lose my vision permanently if I don't lose a LOT of weight soon and to keep it off). I've asked my surgeon to write another letter for the appeal as well showing his support. My insurance is denying me because they are saying I need to have had a MINIMUM of BMI of 40 for past 5 years but my Summary Plan Description does not state those specific wording... even my 1st level denial letter had quoted wording that is NOWHERE in my Summary Plan Description. When I called to ask where this was found insurance kept saying just do 2nd level appeal..... I've reached out to corporate office for consumer affairs for the insurance company for them to look into this as I've had clerical errors from them from the 1st denial letter that were never corrected. I also have a 3rd party that my employer uses to act as "advocate" for me who has reached back out to my employer to find their specific definition they are using for "morbid obesity". Denial reason- no BMI of 40+ for past 5 years Summary Plan Description states - I need a physician to diagnosis me with morbid obesity for past 5 years My HR Benefits Manager states they use industry standard and never gave me a direct answer. Insurance company never gave me a direct answer but by the denial letter and their consumer affairs representative they are stating it is BMI of 40+ and that is standard. Odd as the insurance company has their own policy for bariatric surgery that states morbid obesity is BMI 40+ OR 35+ with at least 1 co-morbidity (which I have) that they use for their fully funded clients (my employer is self-funded so it's really the employer's definition I have to go by). That is my fight right now. I provided tons of "industry standard" that is even found WITHIN the insurance company's own policy stating "morbid obesity" is 40+ OR 35+ 1 co-morbidity.... along with how several of the other big name insurance companies are using for "industry standard". I honestly feel like I can win this as this is the ONLY reason they are denying me.... I had a BMI of 38 and 39 for past 4 years and 40 this year (although in 2013... I'll be 40 again haha! So I need to get re-weighed and submit another 40 number now).

http://www.livestrong.com/slideshow/556857-20-delicious-protein-powder-recipes-that-are-not-shakes/#slide-21 Saw this and thought they were neat ideas. Although they don't have calories, etc. listed I'm sure they can be tweaked some.

Have been denied 3 times... Starting on my 2nd level appeal now. Along with starting open ticket with insurance corporate consumer affairs because of the clerical errors from the insurance and issues with the insurance not correcting them and honoring my requests and giving me definitions for their denial basis, etc. a big ole mess

I'm originally from BR but live in Cali now. If ins. Doesn't approve I may end up in TX or BR for cheaper self-pay options.

Love your shoes! Completely different person!

You look great!

'> That's SO amazing! Congrats on your accomplishment so far. I can't wait to see you in another 3 months!!!

ughh! It quoted the wrong thing. Was directed to OTR

Wait... Guya tell each other if some girl complained about their cum being salty? Lol!!!

Oh... I've literally been overweight since birth! 10 lb baby here!

5'2 HW: 225 (current) - 2010 I only reached 220 @9 months preggie. LW: 159 (2006) That lasted for 3 months I think.... GW: anything below 170! Still in the fight with insurance and my employer!

Sad that your insurance states Pseudotumor Cerebri.... And mine doesn't Do you have bCBS?